Set the stage for telling parents assessment results

by Ellyn Satter, MS, MSSW, Family Therapist and Registered Dietitian

Summarize the positives and negatives of your assessment so parents can relax and hear about what you have found and what you recommend. Parents give you a lot of information about themselves so you can do your assessment, and they are anxious about what you think of them. Following this rubric lets you present the main points kindly and quickly.

Assessment is essential

Established and long-standing feeding problems require assessment, as described in Appendix E, “Assessment of feeding/growth problems, Your Child’s Weight: Helping without Harming. Not only that, but parents often come for help wanting their child’s eating problem fixed, not realizing that the problem grows out of something that they are doing with feeding. Making the shift from child-as-problem to parent-as-solution can be tricky. Issues in one or more areas can impinge on feeding:

• Medical & physical
• Nutrition & food selection
• Psychosocial (parents)
• Developmental (child)
• Feeding dynamics

Give parents a quick overview of assessment and recommendations

Any feeding dynamics assessment generates a lot of information that must be shared with parents. Before you launch into the details of the assessment, take five minutes at most to join with parents and give them a quick look at your results and recommendations. This is intended to reduce their anxiety so they can relax and hear about your findings in more detail. Parents have taken a risk in approaching you for help and by giving you details of their lives. On some level, they feel guilty about the child’s problem with eating. Present your findings by first, joining with and supporting the parents, and second, making your recommendations for change. Avoid activating their defenses by  presenting your results in a way that is not critical and that, in fact, is supportive and understanding. That lets parents, to the greatest extent possible, hear about your findings and take them to heart. If parents interrupt to ask questions during this setting-the-stage part, reassure them that you will get into the detail, but first you need to lay out the main points. After that, you can ask for questions, which will lead you quite naturally into reviewing the rest of the assessment information and recommendations.

Organize your summary into positives and negatives

The positive/negative rubric provides parents with support and understanding, helps win them over on behalf of the child, and allows them to relax and hear what you say. Steps 1) and 2) join with the parent, 3) identifies the problem, and 4) predicts positive outcome.

Parent positive tells parents positives about themselves

Here you join with parents by telling them, truthfully, positives about themselves. These statements apply to any parent who approaches you for help addressing a child’s problem, and you will be aware of others. Joining with parents is particularly important when they are angry and frustrated with their child. It is easier for them to express anger than to feel anxious or defeated; they are frustrated because they feel overwhelmed and afraid.

Child negative agrees with parents about the child’s problematic behavior

Confirm the problem. This step also joins with parents, this time by acknowledging that the child is indeed doing what parents say he is doing, that the problem that the parent brings to you is worthy of note, and that the child is challenging. While your assessment indicates that the child’s negative behavior is in response to the parents’ feeding errors, keep that to yourself for now.

Parent negative tells how parents contribute to the problem

The technique of reframing puts the negative behavior in a positive context, to help the parents accept responsibility without becoming defensive.

Here you give a brief overall description of what parents are doing that contributes to the problem. Use the technique of reframing, which puts the negative behavior in a positive context, to help the parents accept responsibility without becoming defensive: “Because you have been so concerned (parents positive) about Child’s (child negative) you have tried to address it by (parent negative). In the process, you have crossed the lines of the Satter Division of Responsibility in Feeding  (sDOR).

Child positive makes positive predictions for change  

This step joins with parents again by making positive observations about the child. The child loves the parents and wants to please them. Following sDOR will allow him to do that. They have made some common mistakes in feeding but those mistakes are readily corrected. The child in questioin is likely to be young, and when parents change (and stay changed), the child changes right along with them. 

Assessment summary of a four-year-old picky eater

Four-year-old Johnny’s parents are upset because he is picky. You have done a detailed assessment and find that, virtually since birth, the parents have been putting pressure on feeding. From birth, Johnny was a temperamentally cautious and negative child who was difficult to feed. Health advisors reassured them that when Johnny got hungry enough, he would eat. The combination of Johnny’s caution and his parents’ pressure are making Johnny eat fewer and fewer foods.

1. Parent positive: It is clear that you love Johnny and have gone to a lot of trouble for a long time to resolve his eating problems.
2. Child negative: You are quite right. Johnny eats fewer foods that the usual preschooler. Even more concerning, he behaves badly at the table. He puts up a fuss when he sees foods he doesn’t want to eat and that makes meals unpleasant for everyone.
3. Parent negative: Because Johnny has been difficult to figure out and so slow to learn to eat new foods, you have quite naturally tried to help him urging him to eat. As he got older, you have short-order cooked for him. In the process you have crossed the lines of sDOR. Your jobs are to do the what, when and where of feeding and let Johnny do the how much and whether of eating.
4. Child positive: Johnny loves you and wants to please you. But because he is so bright and wants so much to be his own person, he behaves poorly with eating.  Following sDOR will allow him to both please you and please himself. He will do better when you have regular meals and snacks, learn some strategies for being considerate without catering with meal-planning, and let him determine what and how much to eat of what you put before him.

(Still talking with parents) “Now, would you like to hear about the rest of my observations and recommendations?”